Tongue-tie (or ankyloglossia) is an infant’s limitation of protruding and elevating the tip of the tongue due to a short lingual frenulum and/or restriction of the genioglossus muscles.

Tongue-tie influences the growth and development of the mouth cavity and affects functional processes such as chewing, sucking, swallowing, and speech. In addition, the clinical appearance of ankyloglossia can result in painful breastfeeding, an inability to obtain an effective latch, and, as a consequence, poor weight gain.

What is the prevalence of tongue-tie?

The prevalence of tongue-tie (ankyloglossia) is estimated to range from 4 to 11% depending on the population studied (1,2). Recently, research was published on the incidence of ankyloglossia in Andorra (at the Hospital Nostra Senyora de Meritxell) in a cohort of 2,333 newborns between 2016 and 2020 (3).

To conduct the study, researchers obtained the necessary clinical data through the medical records of the perinatal control protocol from birth to 6 months of age. The pediatric service assessed babies at birth through a complete physical examination of the newborn, including a check of the oral cavity and maxillofacial region, diagnosing ankyloglossia according to the Coryllos classification (4). To minimize inter-examiner variability of ankyloglossia, they performed a diagnostic test before starting the study with 20 infants and obtained a diagnostic concordance of 90%.

This research found a prevalence of ankyloglossia of 7.84%. According to the Coryllos anatomical classification, 13 patients (9.5%) had a type I frenulum, 114 patients (83.9%) had a type II frenulum, 8 patients (5.9%) had a type III frenulum, and 1 patient (0.7%) had a type IV frenulum.

Of the 183 newborns with ankyloglossia, frenotomy was performed in 136 patients (74.3%) with ankyloglossia associated with breastfeeding difficulties. In the remaining patients (47 subjects, 25.68%), lingual frenotomy was not necessary: they followed measures of support and improvement of breastfeeding technique by the maternity unit staff of the hospital, thus overcoming the difficulties in breastfeeding.

How does a frenotomy affect the maintenance of breastfeeding?

This article reported a 26.7% decrease in exclusive breastfeeding at 1 month among patients who underwent frenotomy.

Among infants diagnosed with ankyloglossia, maintenance of exclusive breastfeeding in the infants that had undergone frenotomy was similar to that of the nonsurgical group, both at 1 month (73.3% vs. 76.92%), 3 months (67.5% vs. 71.8%) and 6 months (65.84% vs. 71.8%). However, statistically significant differences were found in mixed feeding. The percentage of mixed feeding was higher in infants with the surgical intervention compared to the non-intervention group at 1 month (p = 0.05), 3 months (p = 0.016), and 6 months of life (p = 0.016).

It should be noted that the publication does not clarify whether the group in which frenotomy was performed was also offered support to improve the breastfeeding technique, which could be a limitation and bias of the study.

References:

1. O’Shea JE, Foster JP, O’Donnell CPF, Breathnach D, Jacobs SE, Todd DA, et al. Frenotomy for tongue-tie in newborn infants. Cochrane Database Syst Rev [Internet]. 2017;2017(3).
2. Messner AH, Lalakea L, Aby J, Macmahon J, Bair E. Ankyloglossia: Incidence and Associated Feeding Difficulties. Arch Otorhinolaryngol Neck Surg. 2020;126:36–9.
3. Guinot F, Carranza N, Ferrés-Amat E, Carranza M, Veloso A. Tongue-tie: incidence and outcomes in breastfeeding after lingual frenotomy in 2333 newborns. J Clin Pediatr Dent [Internet]. 2022;46(6):33–9.
4. Coryllos E, Watson Genna C, Salloum AC. Congenitial tongue-tie and its impact on breastfeeding. Am Acad Pediatr. 2004;(Breastfeeding: Best for baby and mother):1–6.